In conclusions,
1. There are differences between normal and MVPS, and the most significant posture is sitting position.
2. In short-term HRV, it is prefer frequency domain analyze than time domain analyze.
3. There are differences between male and female whether in normal or MVPS, especially in frequency domain.
4. Both MVPS and normal cases are affected by postural changes.
Different machines and software were used to analyze in different researches, so there is no official standard normal value in HRV. We hope this study will help to build the database in Taiwanese.
According to 1996 ACC/AHA/ESC consensus[1], short term HRV is suit for frequency domain parameters to analyze. HF presents how parasympathetic nerves control heart rate, LF presents activity of sympathetic nerves and LF/HF presents the balance between sympathetic and parasympathetic nerves.
Normal group and symptomatic MVPS can be significantly differentiated by Time domain‟s SDNN and Frequency domain‟s Total Power. And there are significantly
statistically different of frequency domain HRV parameters in sitting position.
MVPS patients‟ ECGs show the changing ST-T wave[10][11] so their sympathetic nerves are more active than normal people. But in this study result show that normal data is lower than MVPS data in HF, and higher than MVPS in LF. That is to say, sympathetic system is more active in normal than in MVPS. But if it classifies into male and female, then the result in female would be normal group‟s HF is higher than MVPS group, and LF is lower. For female, vagal nerves are more active in normal than in MVPS, and it is the same with clinical study. Male has no significant
difference between normal and MVPS. Maybe it is because male data is not enough and the data has extreme values.
The results show the statistically changing of ANS in MVPS cases. In clinical use, we should consider of not only the analysis of Ultrasound, but also nerve system of patients.
Gender specific HRV variation had been reported in our previous study in normal
Taiwanese[108]. It is further strengthened the digenetic criteria for HRV should be gender specific in MVPS as well. Although the results show that time domain parameters might not be of use for the evaluation MVPS, frequency domain with postural changes might be a useful tool in MVPS diagnosis risk stratification in Taiwanese.
ANS was affected by female hormones, so in female, sympathetic tone will decline and parasympathetic will elevate if comparing with male[109]. Although time domain parameters have no statistically difference could be refer, but in frequency domain, the parameters show that female is higher than male in HF, and is lower in LF and LF/HF ratio. It conforms to our suppose whether in normal group or in MVPS group.
There is no significant difference between lying and sitting posture, but between lying and standing, which have bigger difference in posture, the data exist significant difference. It shows that postural changes will affect ANS, whether in normal group or MVPS group. So it might be implied that postural changes should be included in the future HRV research both on symptomatic MVPS and normal controls.
In lying posture has the higher RR interval. That means it has a lower heart rate and
will have higher SDNN value. That result is the same with the result from Gamelin FX and the group[111]. In frequency domain parameters, lying posture is the highest in HF and the lowest in LF both in normal and MVPS group; whereas standing posture is the lowest in HF and the highest in LF. It means when people in lying posture, their parasympathetic nerves are more active than sympathetic nerves. On the contrary, sympathetic nerves have more activity in standing position.
Our normal cases resource is the university in Hsin-Chu area, and MVPS cases are the patients mostly from hospital in Taipei area. So most normal cases are in 20 ~ 25 years old range, and MVPS cases are in 30 ~ 60 years old range. In the future, we should set an age level group for 10 years to classify the data. We already know in normal case, the older one has a lower HRV value. We also need to collect more data in every age level, especially male in MVPS.
This study is trying to build a HRV standard value for Taiwanese. Nowadays
researches are mostly for Caucasian and African[110]. There is rarely for Asian, even for Taiwanese. People live in different area and environment might have different factor to affect their ANS, and different ethnicity may have some differences in their ANS in nature. Use the standard for Caucasian in other race is not a good choice.
Although Taiwan has no broad land, but there are many mountains. Numerous people live in the high altitude place, and they might be one of our case. This factor that where the case live in flat or in mountain might affect their ANS. In future work, maybe we should consider this factor and collect more cases to prove this suppose.
The HRV measurements are processing form 9:00 A.M to 4:00 P.M, this period might be too long for HRV study because of the diurnal of ANS in humans. Maybe we can try to shorten the experimental time to reduce the mistakes. But also we need more data to be collected that we can exactly classify the data.
Height and weight might also affect the HRV results. The gender different of HRV might not only affected by female hormone, but BMI value. In the future work, we can try to classify data with BMI.
General to say, compared to female, male have more exercise habits. Exercises will also affect HRV results. And we should notice in what vocations the cases are. Some particular jobs need to work at night, and some student groups are used to stay night.
Diurnal is also an important changing factor in ANS. Besides, some people may have great pressure about their jobs, academic performance or their own personal
relationship problems. Mental situation will also affect ANS activity. When people are happy or exited, sympathetic tone is more active. And when they are in low tension, that parasympathetic tone is more active than sympathetic tone. Before we process the test, we should have a discussion with our cases about their life style to make sure the errors are reduced to minimum.
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